Clara Maass Medical Center staff, Lea Rodriguez, RN, vice president of patient services, left, and Frank Mazzarella, MD, vice president of medical affairs, stand in one of 16 bays in the rapid decision unit, the latest addition to the ED to handle the influx of patients.

When Hospitals Close, Remaining Facilities Step Up

News of hospital closures has risen in the U.S., and New York and New Jersey facilities have seen their fair share. According to the New Jersey Hospital Association, 25 hospitals have closed their doors in New Jersey since 1992, and six have filed for bankruptcy in the past three years. Since the early 1990s, the Greater New York Hospital Association lists 34 hospitals in New York City and surrounding counties that have either closed completely or repurposed their facilities for specialty care, such as behavioral health.

The impact of the closures on remaining hospitals has been profound. From continuing with closed hospitals community-focused programs to implementing swing units, hospitals had to learn to adjust.

Rethinking First Contact

In Newark, N.J., St. James and Columbus hospitals closed their doors, straining the healthcare of the community. St. Michaels Medical Center, also part of Cathedral Healthcare System, absorbed some of the displaced patients, but many of the physicians and patients migrated a mile away to Clara Maass Medical Center in Belleville, N.J. In response to the planned closures, Clara Maass administrators took initiative and rethought the structure and flow of the ED, the first contact many patients have with the hospital.

We went from about 45,000 ED visits to about 75,000 annual visits in only a few years, says Lea Rodriguez, RN, BS, vice president of patient services at Clara Maass. Same-day surgery, traditionally closed in the evening and on weekends, found a second life during that downtime as a treat-and-release annex of the ED. To speed the progress of patients through the department and toward the correct level of care, the hospital established an express area where standing orders for lab work, electrocardiograms and radiology testing could be implemented so results were ready for physicians to review.

We met with the emergency medical technicians and ambulance units in the area to let them know about our discharge and internal triage nurse who functions as the primary contact for ambulance patients and the emergency personnel who bring them in, Rodriguez says.

Utilizing a swing unit that opens and closes as needed to accommodate extra inpatient load gives the hospital flexibility, says Frank Mazzarella, MD, vice president of medical affairs. He noted that historically, there were no advanced practice nurses employed by the medical center. During this period of transition and growth, at the request of physicians a nurse practitioner was added to the surgical department. Physicians who had transferred from the closed hospital were used to having a nurse practitioner on staff and realized the benefits of the position. Shes been a tremendous addition, Mazzarella says. We are now at the 100th percentile in core measures for the surgical program, and our patient satisfaction scores are greatly improved.

Being Proactive

When St. Agnes Hospital in White Plains, N.Y., abruptly closed its doors in 2004, White Plains Hospital Center absorbed the additional volume, says Leigh Anne McMahon, RN, MS, CCRN, vice president of nursing. The following year there was more lead time when United Hospital in Port Chester closed, so White Plains Hospital Center administration was able to be more proactive. White Plains human resource representatives met with individuals at United Hospital to offer positions when appropriate.

But the hospital has adjusted more than staffing levels to meet the needs of the community. For example, St. Agnes Hospital had offered a multiple sclerosis program that was reconstituted at White Plains, so those patients would have continued specialized services.

The services offered by the Family Health Clinic are increasing year by year for the underinsured and noninsured, McMahon says. We offer family-focused care, including making sure that the children receive appropriate vaccinations, and that their health records are accessible to the family as they need them for school and other purposes. Our electronic records will follow the individual as they move through the healthcare settings.

She adds that family nurse practitioners were introduced and have taken on more teaching and general health promotion. Were building trust relationships in the community to educate about prevention, McMahon says.

Blending Families

In New Jersey, Passaic (N.J.) Beth Israel Medical Center and Passaic General Hospital were consolidated into one hospital that was then absorbed by St. Marys Hospital-Passaic. The three hospital families merged gradually. We had to blend three distinct cultures into one unified force, says Christina Fischer, RN, MSN, CNL, APMN, FACCN, vice president of nursing services at St. Marys Hospital-Passaic.

The loss of the other facilities did not mean the community lost services, Fischer says. Instead, centers of excellence from each of the institutions were reconstituted and augmented to offer even better services to the community. Were all very excited about the growth that is going on, Fischer says. The community now has one place to go for comprehensive services. Its really not a matter of focusing on the past; were planning for the future.

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